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[Cardiovascular disease: big problems require big solutions]
1Academisch Medisch Centrum, afd. Cardiologie, Amsterdam, the Netherlands. r.j.peters@amc.uva.nl
Insights
Cardiovascular disease risk is high for middle-aged adults. An optimal risk profile offers 14 more healthy years, but few achieve it, suggesting population-wide interventions like a
Area of Science:
- Cardiovascular epidemiology
- Preventive cardiology
- Public health
Background:
- Cardiovascular disease (CVD) poses a significant lifetime risk, affecting 60% of men and 55% of women by age 45.
- An optimal risk profile is rare, with only 4% of men and 8% of women achieving it.
- Low-risk individuals gain an average of 14 healthy years.
Purpose of the Study:
- To assess the lifetime risk of cardiovascular disease in middle-aged adults.
- To evaluate the impact of an optimal risk profile on longevity.
- To explore population-level strategies for CVD prevention.
Main Methods:
- Analysis of over 900,000 individuals across 5 prospective US cohort studies.
- Examination of cardiovascular disease risk factors and lifetime risk.
- Evaluation of the benefits associated with an optimal risk profile.
Main Results:
- High lifetime risk of cardiovascular disease by age 45 (60% men, 55% women).
- Limited prevalence of optimal risk profiles (4% men, 8% women).
- Significant health benefits (14 years) associated with an optimal risk profile.
Conclusions:
- Identifying high-risk individuals alone is insufficient for widespread CVD event prevention.
- Population-wide strategies, such as a 'polypill' approach or societal lifestyle changes, are needed.
- The 'polypill' strategy offers a potentially affordable and effective public health intervention for cardiovascular disease prevention.
Abstract:
At the age of 45, the lifetime risk of developing cardiovascular disease has been shown to be 60% in men and 55% in women in an analysis which included over 900,000 individuals in 5 prospective cohort studies in the United States. Only 4% of the men and 8% of the women had an optimal risk profile. The benefits of being at low risk were great: 14 more healthy years in those without risk factors. Identifying middle-aged individuals at high risk will prevent only a minority of clinical events. There are two alternatives that can be considered; the first one being the 'polypill' approach in which multiple generic drugs are started by every individual at a certain age, e.g., 55 years. This could prove to be an affordable and effective approach for the entire population. Alternatively, fundamental changes in society aimed at improving lifestyle and dietary habits could be implemented.
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